Gregory W. Schrimsher

Relation Between Cognitive Testing Performance and Pattern of Substance Use in Males at Treatment Entry

This study examined the frequency and pattern of cognitive impairment in individuals entering substance use disorder treatment and additionally examined the relation between pattern of cognitive impairment and type of substance(s) used: alcohol (n = 116), cocaine (n = 49), alcohol/cocaine (n = 76), and alcohol/multiple substance (n = 54). The Cognistat, a screening measure of cognitive functioning, and the Addiction Severity Index were given to male veterans at the time of entering 3- to 4-week residential/day drug treatment. The most prominent areas of impairment were memory (37% of the total sample) and similarities or abstract concept formation (21% of the total sample). Moderate or greater severity of impairment was noted on at least one Cognistat scale in 35% of the participants. Results indicated no significant differences in the patterns of cognitive domain impairment between groups based on type(s) of substances used at the time of entering treatment. Multiple substance use was significantly related to greater levels of psychiatric problems as identified by the Alcohol Severity Index. Given the rate of impairment in memory and verbal abstract reasoning noted, it is suggested that cognitive screening be a standard consideration in residential substance use disorder treatment to assist in treatment selection and delivery that is optimized to provide maximal benefit to patients.

Executive functioning mediates the link between other neuropsychological domains and daily functioning: a Project FRONTIER study.

BACKGROUND The purpose of this study was to examine the mediating impact of executive functioning on the link between other neuropsychological domain scores and informant-based rating of functional status. METHODS Data on 181 participants were analyzed from an ongoing epidemiological study of rural health, Project FRONTIER (mean age = 64.6 ± 13.8 years, 69% women, 42% Mexican American). Executive functioning was assessed by the EXIT25 and other neuropsychological domains were assessed via the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Informant-based rating of functional status was assessed via the Clinical Dementia Rating Scale sum of boxes scores (CDR SB). RESULTS RBANS Index scores were each significantly (p < 0.05) related to CDR SB scores and EXIT25 scores. EXIT25 score was a significant partial mediator of the link between four RBANS indices (Immediate Memory, Attention, Visuospatial/Construction, Delayed Memory) and CDR SB scores, and a complete mediator of the fifth index (Language). CONCLUSION Executive functioning is a mediator of the link between other neuropsychological domains and daily functioning. Neuropsychological assessments that do not measure executive functioning will provide only a partial clinical picture with adults and elders.

Assessment Reactivity: Can Assessment of Alcohol Use During Research be an Active Treatment?

Assessment reactivity refers to the finding that the action of having a behavior queried, monitored, or become a focus of attention during a research study independently can affect the expression of that behavior regardless of other interventions or manipulations used in the study. This article reviews recent efforts to empirically evaluate the independent impact of assessment reactivity on reducing alcohol use and problems in addition to examining how assessment reactivity may act to reduce alcohol use and related problems. The potential of taking advantage of assessment reactivity in alcohol use disorder treatment is discussed.

The Relation Between Ethnicity and Cognistat Performance in Males Seeking Substance Use Disorder Treatment

This study examined the relation between ethnicity and results obtained during standard administration of the Cognistat, a screening measure of cognitive functioning, in a sample of male veterans seeking substance use disorder treatment (n = 312). Results indicated that screening items for the Naming, Calculation, and Similarities subtests were missed significantly more frequently by African American compared to Caucasian veterans, although the frequency of identification as impaired on the full metric portion of this scales did not differ based on ethnicity. The mean scores on the metric items for these three scales were very similar between groups. Additionally, African American veterans diverted to the Constructional Ability metric items had significantly lower scores on items from that subtest. Logistic regression analyses of impairment identification on the various subtests indicated that ethnicity was a significant (p < .005) predictor beyond the covariates of age and years of education for the Calculation subtest, but only accounted for 4.8% of the variance. Based on the results of the current study, it is recommended that 1) the entire Cognistat be administered regardless of screening item performance to minimize the risk of potential ethnic or cultural based performance bias and 2) a prospective study of potential demographic bias based on comparing Cognistat screening results to a battery of specific neuropsychological assessments of the same constructs be performed to maximize the potential specificity and sensitivity of this assessment for all demographic groups. The authors acknowledge the support of the South Central Veteran Affairs Health Care Network Mental Illness Research Education and Clinical Centers (MIRECC) in completion of this project

The California Verbal Learning Test-Children's Version: relation to factor indices of the Wechsler Intelligence Scale for Children-Third Edition.

The California Verbal Learning Test-Childrens Version (CVLT-C) provides clinicians with a method of assessing various aspects of childrens verbal memory and has been found to be sensitive to memory deficits resulting from a variety of neurological conditions. Intuitively, the CVLT-C would be expected to be highly related to a childs verbal cognitive abilities; however, with only a few exceptions, the relationship of this test to various domains of cognitive function has not been broadly studied empirically. To examine this issue, we evaluated the amount of unique variance in CVLT-C scores that could be predicted by the Verbal Comprehension, Perceptual Organization, Freedom from Distractibility, and Processing Speed indices of the Wechsler Intelligence Scale for Children, Third Edition (WISC-III) beyond that accounted for by age and gender in a sample of 62 children referred to an outpatient psychiatry clinic for neuropsychological evaluation. While the Processing Speed Index predicted a significant amount of variance for both short and long delay free and cued recall, the Verbal Comprehension Index was a poor predictor of CVLT-C performance on all outcome variables, accounting for only 1.5 to 4.5% additional variance above age and gender. These findings indicate that while the CVLT-C may be relatively independent of influences of verbal intelligence and abstract verbal reasoning, general speed and efficiency of processing play an important role in successful encoding for later retrieval on the CVLT-C.

Total Cholesterol and Neuropsychiatric Symptoms in Alzheimer's Disease: The Impact of Total Cholesterol Level and Gender

Background: Neuropsychiatric symptoms (NPS) in Alzheimers disease (AD) are a major factor in nursing home placement and a primary cause of stress for caregivers. Elevated cholesterol has been linked to psychiatric disorders and has been shown to be a risk factor for AD and to impact disease progression. The present study investigated the relationship between cholesterol and NPS in AD. Methods: Data on cholesterol and NPS from 220 individuals (144 females, 76 males) with mild-to-moderate AD from the Texas Alzheimers Research and Care Consortium (TARCC) cohort were analyzed. The total number of NPS and symptoms of hyperactivity, psychosis, affect and apathy were evaluated. Groups based on total cholesterol (TC; ≥200 vs. <200 mg/dl) were compared with regard to NPS. The impact of gender was also assessed. Results: Individuals with high TC had lower MMSE scores as well as significantly more NPS and more symptoms of psychosis. When stratified by gender, males with high TC had significantly more NPS than females with high TC or than males or females with low TC. Conclusion: The role of elevated cholesterol in the occurrence of NPS in AD appears to be gender and symptom specific. A cross-validation of these findings will have implications for possible treatment interventions, especially for males with high TC.

Substance Use Disorder Education for Medical Students: Reflections on Our Betty Ford Institute Training Experience

This article shares the personal reflections of four 3rd-year medical students and two faculty members from the Texas Tech University Health Sciences Center who participated in the Summer Institute for Medical Students (SIMS) program provided by the Betty Ford Institute. The SIMS program is a one-week experiential program of participating in treatment activities with patients and their family members at the Betty Ford Center as well as educational instruction on addiction as a treatable disease. We would like to share how the SIMS experience affected us as professionals and individuals and how we will incorporate this experience in our future efforts as health care providers and educators.

Introduction: From Benches to the Trenches: Diverse Ways Research Can Inform and Assist Alcoholism Treatment

With its focus on addressing concerns and issues of the range of professionals providing care and services for individuals with alcohol use disorders and their families, the Alcoholism Treatment Quarterly fills an important role among professional journals. The membership of the South Plains Alcohol and Addiction Research Center at the Texas Tech University Health Sciences Center is honored to be invited to share our perspectives and interests regarding alcohol use disorders research with the readership of the Alcoholism Treatment Quarterly. Often when we think of alcohol use disorder research, we visualize the development of novel pharmacological treatments or new and more efficacious therapy approaches to treat our patients. It is also important to remember that the research process itself can provide unanticipated insights into treatment as well as ongoing clarification of previous research and treatment knowledge. The benefits of research with regard to improving treatment are not limited to randomized controlled studies of an intervention tested in a selected screened patient sample but can come from multiple aspects of research from basic science to clinical intervention feasibility studies. It is very important that researchers continually attempt to communicate this information to the treatment community. Consequently, our focus in the current issue is to illustrate several ways research can support and inform the ongoing efforts of the treatment community. The initial article discusses the phenomenon of ‘‘assessment reactivity’’ that refers to the phenomenon that when a behavior is formally assessed or queried that assessment can affect the expression of the behavior regardless of whether an experimental intervention is received (Schrimsher & Filtz). The consequence of this in terms of alcohol use treatment research is that if one does a detailed assessment of alcohol use on a study participant,